血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较

doi:10.19438/j.cjoms.2021.05.009

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (5): 434-438.doi: 10.19438/j.cjoms.2021.05.009

血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较

杨宗燕, 康一帆, 吕晓鸣, 张雷, 单小峰, 蔡志刚

北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔疾病临床医学研究中心, 口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,北京 100081

收稿日期:2021-02-19 修回日期:2021-05-08 出版日期:2021-09-20 发布日期:2021-10-20
通讯作者: 单小峰,E-mail：kqsxf@263.net
作者简介:杨宗燕（1993-）,女,硕士研究生,E-mail：18337174875@163.com
基金资助:
首都卫生发展科研专项项目（CFH2020-2-4102）; 北京大学口腔医院国家重大疾病多学科合作诊疗能力建设项目（PKUSSNMP-202015）

Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps

YANG Zong-yan, KANG Yi-fan, LV Xiao-ming, ZHANG Lei, SHAN Xiao-feng, CAI Zhi-gang

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology. Beijing 100081, China

Received:2021-02-19 Revised:2021-05-08 Online:2021-09-20 Published:2021-10-20

摘要/Abstract

摘要： 目的通过比较髂骨嵴不同朝向重建下颌骨缺损后的对称性和是否符合种植牙治疗标准,分析血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点。方法回顾2017年1月—2019年12月于北京大学口腔医院行髂骨瓣重建下颌骨缺损的患者的基本信息和术后CT资料,根据髂骨嵴的朝向分为髂骨嵴朝向牙槽突组和髂骨嵴朝向下颌骨下缘组。CT影像资料导入Proplan软件,测量2组髂骨重建后的对称性;导入Simplant软件,测量髂骨骨块长度,相对于患侧上颌1、3、6牙3个位点对应的髂骨高度、牙槽突侧骨宽度以及颌间距离。采用SPSS 25.0软件包对数据进行统计学分析。结果 30例患者纳入研究,每组各15例,平均年龄37.7岁。LC缺损类型在颏孔点下缘位置朝向牙槽突组非对称率（4.9%）显著小于朝向下颌骨下缘组（18.2%,P<0.05）。朝向牙槽突组和朝向下颌骨下缘的骨长度分别为(49.43±4.17)mm、(52.25±3.79)mm（P=0.102）。相对于患侧上颌1、3、6位点的牙槽突侧髂骨骨宽度朝向牙槽突组分别为(11.40±0.63)、(12.15±0.46)、(13.15±0.62)mm,均显著大于朝向下颌骨下缘组的(7.93±0.55)、(8.97±0.34)、(8.70±0.49)mm（P<0.05）;相对于上颌6位点的髂骨骨高度在朝向牙槽突组为(29.80±1.17)mm,显著大于朝向下颌骨下缘组的(25.42±1.17)mm（P<0.05）。相对于上颌6位点的颌间距离,朝向牙槽突组为(10.89±1.07)mm,显著小于朝向下颌骨下缘组的(14.33±0.76)mm（P<0.05）。结论在血管化髂骨瓣修复重建下颌骨有牙区缺损时,髂骨嵴朝向牙槽突侧较髂骨嵴朝向下颌骨下缘侧有更好的对称性,更充足的牙槽嵴宽度及更合适的颌间距离。

关键词: 髂骨嵴, 下颌骨缺损, 对称性, 颌骨重建, 颌间距离

Abstract: PURPOSE: In this study, the symmetry of neomandible and whether meeting the standard of dental implant after reconstruction with iliac bone flap were measured to make sure the advantages and disadvantages of different iliac crest orientations. METHODS: Patients who underwent mandibular defect reconstruction with iliac bone flap at Peking University School and Hospital of Stomatology from January 2017 to December 2019 were included in this study, and divided into iliac crest oriented to alveolar process group (group A) and iliac crest oriented to lower mandibular margin group (group B). The patients' basic information and CT image data after operation were collected. Simplant and Proplan software were used to measure the symmetry, the length of bone segment, the height, the width of alveolar process side and the distance between jaws and iliac crest after reconstruction(opposite to upper incisor,canine and first molar). The data was analyzed using SPSS 25.0 software package. RESULTS: There were 15 patients in group A and B respectively, the average age was 37.7 years old. The asymmetry rate of LC defect type at the lower edge of the mental foramen in group A was less than that in group B. There was no significant difference in bone length between group A (49.43±4.17)mm and group B (52.25±3.79)mm. The widths of occlusal side in group A (opposite to upper incisor, canine and first molar) were (11.40±0.63), (12.15±0.46), (13.15±0.62)mm, and (7.93±0.55), (8.97±0.34), (8.70±0.49)mm(P<0.05) in group B, respectively. The bone height opposite to upper first molar was(29.80±1.17)mm in group A, which was significantly higher than (25.42±1.17)mm in group B(P<0.05). The intermaxillary distance of group A was less than that of group B, the distance of first molar was (10.89±1.07)mm in group A and (14.33±0.76)mm in group B(P<0.05). CONCLUSIONS: When mandibular dentulous defect is reconstructed with vascularized iliac bone flap, the iliac crest oriented to the alveolar process side can get better symmetry, wider alveolar ridge and more suitable intermaxillary distance than iliac crest oriented to the lower margin of the mandible.

Key words: Iliac crest, Mandibular defect, Symmetry, Reconstruction, Intermaxillary distance

中图分类号:

R782.2

杨宗燕, 康一帆, 吕晓鸣, 张雷, 单小峰, 蔡志刚. 血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较[J]. 中国口腔颌面外科杂志, 2021, 19(5): 434-438.

YANG Zong-yan, KANG Yi-fan, LV Xiao-ming, ZHANG Lei, SHAN Xiao-feng, CAI Zhi-gang. Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps[J]. China J Oral Maxillofac Surg, 2021, 19(5): 434-438.

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血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较

Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps

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